Our goodwill taken for granted, nurses have been pushed to the point of strike action, feeling like we have nowhere else to go, writes Phil Ní Sheaghdha
Striking doesn’t come naturally to nurses and midwives. In the hundred-year history of the INMO, we have gone on national strike just once.
This is doubtlessly because we have always been a caring profession, motivated by the support we can provide our patients.
Nurses and midwives are well known as the kind of people who will “just get on with it” when faced with difficult circumstances. Indeed, that ethic was something instilled in me when I trained as a nurse myself.
So how then do we end up with 95% of nurses and midwives voting for strike action at the end of this month?
The simple answer is that we have been pushed to this point, feeling like we have nowhere else to go. We have gone from process to report and back again, kicking the can down the road. Nurses and midwives increasingly feel that our professional goodwill is taken for granted.
In the last 10 years, the number of nurses and midwives in the public health service has fallen by more than 1,400 — a 4% drop. Meanwhile, the number of managers, consultants, doctors, and therapists have all risen by around 40%.
This relative collapse in our numbers reflects the difficulty the HSE is having in recruiting and retaining nurses and midwives. They simply cannot hire enough of us on these wages, and now get only one application for every four vacant posts.
The effects of the resulting understaffing are well documented, in this newspaper and elsewhere.
We have waiting lists a mile long, where patients get sicker and sicker while they wait.
We hear regular stories of missed or unsafe care, as hard-working health workers struggle to keep pace.
And, as the INMO daily figures reveal, we see the numbers of patients stuck on trolleys rise and rise.
Cork University Hospital is among the very worst-hit by the trolley crisis. Yesterday, it had an eye-watering 70 patients waiting on trolleys, without a bed. Considering there are only supposed to be a maximum of 12 patients in its emergency department, the problem is clearly out of hand.
This worsens patient outcomes. Stuck on a trolley, patients are under bright, 24-hour lights, with no privacy or space for visitors. Recovery takes far longer in such circumstances, as a stay in our health system takes its toll. Healthcare is supposed to make people better, not sicker.
This understaffing is bad value for money too. The HSE now spends over €1.5m a week on expensive agency nurse staffing, used to fill the gaps where permanent nurses should be.
The HSE also has to look overseas to recruit nurses and midwives from other parts of the world. It now pays a whopping €10,000 per head to recruitment firms for nurses hired overseas. We are lucky to have so many brilliant migrant nurses in Ireland, but many leave Ireland within two years — drawn away for the same reasons as Irish nurses.
We train over 1,700 nurses and midwives each year in Ireland. According to student polling we did last year, the main reason so many are considering leaving is because of wages and conditions.
Denial increasingly appears to be the political philosophy of this government. It dismisses and diminishes our concerns on understaffing, insisting its current pay proposals are acceptable. The fact that 94% of INMO nurses and midwives disagree does not appear to give it pause for thought.
But there is hope.
The government’s own research has found enormous benefits to getting the mix and number of staff right. In wards in three Irish hospitals, it trialled safe staffing levels with a mix of 80% nurses to 20% healthcare assistants.
The results were astonishing. The workforce stabilised, with less staff turnover and improved job satisfaction. Patients reported far better outcomes, wait times went down, durations of stay fell, and the number of patient deaths decreased.
The results will impress financially minded readers too. By bringing in enough staff, the HSE actually saved money, primarily because of shorter stays for patients and a drastic 95% reduction in the need for agency staff.
This is not abstract theorising. This is the result of government-sponsored trials, right here in Ireland. The safe staffing framework was launched as government policy with much ministerial fanfare, but low wages and investment have left it unimplemented.
Sadly, without a pay rise, we will not be able to hire enough nurses to make it a reality. I worry it will simply be another report gathering dust on a shelf.
There is a sense in Irish politics that our health service is hopeless and beyond repair. I do not accept this. Nurses and midwives do not accept this. And nor do patients. There is no reason why Ireland cannot have a top-class health service, consistently delivering the standards of care which patients deserve.
To get there, we need the government to listen to the frontline, engage with us directly, and pay nurses and midwives a competitive wage. There is room to do so under the existing pay agreements. This strike can be averted, but it’s time for the government to act.
Phil Ní Sheaghdha is general secretary of the Irish Nurses and Midwives Organisation.